【作者】 王英；

【导师】 张孔来；

【作者基本信息】 中国协和医科大学 ， 流行病学， 1997， 博士

【摘要】 随着AIDS出现和蔓延，性病患者正确求医行为在预防控制STD／HIV中的作用将越来越引起世界各国的重视。与性病诊治、危险因素、流行趋势相比，国内外性病患者求医行为研究，无论在理论及实践上都是一薄弱环节。有关求医行为，尤其是以性病患者为对象的研究鲜有报道。随着STD在我国死灰复燃，国内文献已提及患者求医行为，但尚未开展系统性理论性研究。因此，为了促进性病患者正确求医行为，达到控制STD／HIV和完善求医行为研究目的，本调查对我国性病患者三种主要求医途径：正规性病门诊723名确诊患者、4家药店、9家街头广告非法私人诊所、15名非法私人诊所求治性病者进行定量定性研究。性病患者求医行为涉及性行为、多性伴敏感问题，资料收集难度大。本研究采用个人访谈、深入访谈等技术接近访谈对象。结果表明：患者为了获得有效治疗采用不同方式、到达不同地点多次、混合就医。因此提示，应将首诊得到正规治疗做为今后促进正确求医行为的干预目标。济南患者同样体现多次、混合求医模式，但就诊时间、就诊次数比北京患者长且多、选择非法私人诊所比例高。 本研究基于健康信念模式Logistic分析发现，影响患者首诊能否获得正规治疗因素为：初诊是否怀疑得性病、是否知道有治疗性病正规医院、是否不愿去医院治疗性病、是否了解性病危害及首诊就医地点。影响患者就诊时间因素为：性病正规医疗机构知晓度、是否了解性病危害、性病种类、婚姻状态和性伴数。性病预防知识得分较高、初诊知有性防所患者倾向于选择性防所，就近就医选择综合医院皮肤性病科。 本调查将定性定量方法相结合，弥补了门诊患者定量研究在求医途径和求医动机的不足。阐明了非法私人诊所、药店、性病患者隐私心理在求医行为中的作用；阐明了患者选择非法私人诊所的条件及除个人隐私心理以外影响求医行为的其他因素。 总之，本研究一方面从控制STD／HIV角度探讨性病患者求医行为模式及影响因素，另一方面对求医行为，这一尚无多人问津领域，在研究内容、指标和方法上加以完善扩充，并深入到最终解释人们行为的社会心理学模式，为今后促进患者正确求医行为的干预计划确定了目标和理论基础。将社会学、人类学的定性研究引入流行病学领域，是方法学上的新尝试，是生物医学模式向生物—心理—社会医学模式转变方法上的具体实践。定性定量相结合，甚至单独使用定性方法可用于解决医学领域研究课题。更多还原

【Abstract】 As HIV/AIDS has been worldwide problem, more attention should be paid to the role that health care seeking behavior of patients with STDs plays in the prevention and control of STD/HIV. However, in contrast with the researches focusing on diagnosis, treatment, risk behavior and epidemic tendency of STDs, few theoretical and empirical work has been done to study the health seeking behavior of patients both at home and abroad. With the resurgent of STDs in our country since 1977, health care seeking behavior of STD patients has been seen in the Chinese literature recently, but thorough and theoretical research about it has not been carried out yet. Under the challenging of such background with the remarkably increasing incidence and new cases of STDs and HIV reported in our country, a quantitative study combined with qualitative one has been conducted to elucidate the patterns and influencing factors of health care seeking behavior about STD patients in Beijing and Jinan of Shandong province. Four subjects were included in the study: long distance truck drivers, STD patients attending the special clinics and general hospital, illegally private clinics and persons visiting such clinics for the treatment of STD and suspected STD, drug stores and clients purchasing the drug for the treatment of STD. The methods used to collect data were personal interview, in — depth interview, non — participant observation, et al. Since the health care seeking behavior with STD patients involves the sensitive topics about sexual behavior, multiple sexual partners and social norms about sex, key informants, drug stores and persons visiting illegally private clinics were hard to approach, the data collection in qualitative phase was much more difficult than in quantitative in this study.The quantitative study showed that of 445 STD patients through personal interview in Beijing, 48.1% of them selected special STD更多还原